Self Harm and Treatment Options-1 Hr Presentation

8/9/2019 Self Harm and Treatment Options-1 Hr Presentation

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Self Harm and Treatment

Options

More Than Just Coping Skills


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Goals for Today Learn something you didnt know before

Develop a game plan for the difficult ones Laugh & keep from being bored

Get out early


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History of Self Harm Ancient Greece-captured warriors

Religion & penance-flagellants 1897-Gould & Pyle- Needle girls

1960s-Research focused on in-patient

settings

1987-Dr. Armando Favazza-Bodies Under

Siege


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Definitions for Us Today Not for us

Major self harm-true mutilation due to

psychotic disorders

Mental Retardation/Pervasive Developmental

Disorders

Body Modification-but well revisit it


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Our Focus of Behaviors Minor Self Harm

Not designed for death, but can lead to

significant problems

Repetitive and systematic

Usuals-cutting, burning/branding, scratching

Anorexia Nervosa/Bulimia Risky behaviors-sex, drugs, dangerous relationships


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Co-morbidity Depression & Mood Disorders

PTSD & Acute Stress Disorder

Anxiety Disorders

Personality Disorders (mostly Cluster B)

Substance Abuse & Dependence


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Goals for the Behavior Different than the Why?

Not concerned with the origins, just the specific

behaviors and what benefit they serve

Ask What? instead

What are the benefits?

What is the goal? What is the reaction of those around it?


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Goals (cont.) How do we identify the possible goals of

the behavior?

Where are the cuts?

Whats the ritual/pattern to the self harm?

Wheres the focus of attention and reaction?

When in doubt, ask.


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Potential Goals Attention Seeking

My most despised reason ever given

Kinda garbage, but kinda not


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Purpose & Goals (cont.) Connect with the feeling world

Validate/Symbolize emotions

Dissociation and numbness-Angelina Jolie Reconnects with emotions and life

Fits well with the symptoms of PTSD

Release the stress or negative feelings Think circuit breaker

Biological support-endorphins


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Purpose & Goals (cont.) Common theme-

Control

Body Modifications


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Purpose & Goals (cont.) Family dynamics & cybernetics

Serves a purpose not just to the self harmer, but

to the family system as a whole

Homeostasis

What benefit do these actions serve for the family

and the roles they may play

Everyone works together to keep the system in place


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Treatment Goals Reduce/Remove the behavior

Teach how to gain goals without the self

harm

Restructure the family/system to reduce the

benefit of the actions


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What type of change do we

want? 2 ways we can create

change in the family

A riddle for you-please connect these 9

dots with four lines

(not curvy lines!)

without lifting yourpen.


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Types of Change 1st Order Change-a change within the rules

Most common type of change

Works from given or perceived parameters

Great in simple situations-thermostat

Content focused-ignores the rules that govern

it


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1st

Order Change (cont.) Change is minimal due to the rules staying

the same, and old behaviors can return

More of the same ideas

Do the opposite of the problem

Can create a solution as the problem issue-

Prohibition

Force vs. Resistance-think of the

homeostasis


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2nd

Order Change We cannot solve our problems using the

same thinking that created them. Albert

Einstein

Focuses on changing the rule

Thinking around corners-riddles


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Return of the 9 Dot Problem Self imposed rules keep the task impossible

The construction and definition of the problem,

not the problem itself, becomes the problem


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2nd

Order Change (cont.) Change must begin with understanding the

reality then challenging it

Once an event/object gets a category, its

hard to think of it as something else

If the game changes, then it cant go back

because the rules have changed.


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2nd

Order Change (cont.) 4 Step Process

Clear definition of the problem in concrete

terms

Investigation of the solutions that failed

Clear definition of the concrete change desired

Create & implement a plan


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How do we help do this? Understanding the homeostasis

Understanding the reality and the

language

Understanding your own rules and reality

Challenge this reality with a new

categorization


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Interventions Medications

Focused on the diagnosed issue

Antidepressants

Mood Stabilizers

Anti-psychotics


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Structure of Therapy Individual

Family

Sometimes more beneficial, even without the

patient/client

Think of the homeostasis-what does the

behavior give the other members of the family? Group-watch for the evil Contagion


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Warning Professionals!

Do Not Try These in the Office! Logic

Future consequences

The effect on others

Lecturing

Stewart Smalley Straight coping skills


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Conceptualization & Specific

Intervention Ideas

Dialectical Behavior Therapy (DBT)

Research supports usage with borderline

personality disorder

Intricate and structured-asks a great deal of

investment from the system of the patient

Achilles Heel is this investment and structurefrom others (clinical, family, etc.)


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Structure of Personality Disorders Each role is designed

to avoid responsibility

Creates drama todeal with internalconflict

Think Popeye

Hero Victim

Persecutor

DBT seems toreinforce these roleswith Hero &Victim specifically


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Specific Plans for Personality

Disorders Call out the pattern/role-change the rules

Poker tells

Focus on self-the new Golden Rule

Limit the number of sessions-6-8 max

Give time between sessions-their crisis

may not be a crisis Help make the personality disorder into a

style-Dexter them


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Self Harm Interventions

Pattern Recognition and Replacement

Basic cycle work

Logical but can be beneficial if sold right

Works well with compliant clients Triggers-teach them how to avoid them or ID

how they cause them-gives control back

Thoughts-new thinking about the triggers

themselves Physical cues-Coping skills-delay the cutting

until the change in thought can help

Look for the behaviors that give the same

benefit without the present costs


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Self Harm Interventions (cont.)

Harm reduction model

Solution focused concepts

Focus on the harm it causes the patient from the

patients perspective

Develop plans to reduce it without pushing the idea of

removing it and dealing with the negatives

Identify pattern, develop interrupters at each point until

the patient can cut at the right times

Informed consent-challenge them to look at how toaccept the costs they have chosen & challenge the

fantasy they have with the cutting

Model gives control, which is a basic goal for actions


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Self Harm Interventions (cont.) Addiction and 12 Step Approach

Tolerance &Withdraw

Structures life to deal with stressors without

using the addictive behavior

Connections to others and support network


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Self Harm Interventions (cont.) Family therapy

Messing with the system

Reframing the problem as a family issueinstead of an individual issue

A positive spin on the negative action-thinkof the homeostasis

Must understand and believe their view

Sell them on a new view that changes theunderstanding of the behavior


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Ways to Develop a Good Reframe

How does the behavior help the family?

Think of the goal for the patient-how can

you turn that around so it does the opposite?

Think plausible but uncomfortable to the

patient/family

Advertising-wheres the hook?

Let them figure some of it out


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Self Harm Interventions (cont.) Prescribe the problem

Set different limits for the time they can do it

and how

Reward the problem behavior

Odd interrupter-Flip a coin


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Questions?

If I cant answer it, Ill make

something up.


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Suggested Readings Fishing for Barracuda-Joel Bergman

Change-Paul Watzlwick, John Weakland,

Richard Fisch

The Family Crucible-Augustus Napier &

Carl Whitaker

Clues and Keys-Steve de Shazer

Bodies Under Siege-Armando Favazza

Documents

Self Harm and Treatment Options-1 Hr Presentation